D042

PDF page 619 / N39

Fractures - dislocation(s)
      No Reduction
   UVC - Coccyx................................................................................ visit.fee
   UVC - Pelvic Ring .........................................................................  visit.fee
   UVC - Sacrum ............................................................................... visit.fee
   UVC - Femoral neck, pertrochanteric, intertrochanteric,
           trochanteric, subtrochanteric ..............................................         visit.fee
   UVC - Acetabulum ........................................................................    visit.fee
      [Commentary:
      Application of femoral fracture transport splint, skin traction or pelvic sling constitute
      emergency splinting rather than closed reductions. These are included in visit fee, if
      performed.]
      Closed Reduction
      Pelvic ring
# F134 - Closed reduction of anterior and/or posterior pelvic ring
           fracture(s) and/or dislocation(s) including rigid external
           fixation of anterior/posterior pelvic ring and/or percutaneous
           fixation of anterior pelvic ring. ............................................                6      750.00    6
# D059 - Closed reduction of sacrum and/or unilateral SI joint
           dislocation, with or without closed reduction of anterior
           pelvic ring fracture(s), including percutaneous fixation of
           sacrum and/or SI joint ........................................................                      800.00    6
  E555 - rigid external fixation to D059............................... add 50%
  E569 - percutaneous fixation of anterior pelvic ring only, to D059
            ............................................................................. add 50%
# D042 - Hip dislocation ....................................................................                   268.25    6
      Open reduction
# F135 Anterior pelvic ring fracture excluding sacrum, sacro-iliac
          joint(s) or acetabulum.........................................................                6      950.00    8
# D060 Sacrum and/or unilateral sacroiliac joint .................................                       6      950.00    6
# D052 Lips .........................................................................................    7      922.90    8
# D046 One pillar ................................................................................       6     1458.50    10
# D047 Two pillars...............................................................................        8     2187.15    12
# D043 Hip dislocation ........................................................................          7      406.45    7
# R628 Hip dislocation, late, after four weeks .....................................                     7      774.90    10
# F100 Femoral neck, pertrochanteric, intertrochanteric, trochanteric –
          cannulated screws, pin/plate and screws or intramedullary
          fixation with proximal and distal locking screws .................                             6      771.75    10
# F101 Primary prosthesis, femur only (includes Moore, Thompson,
          Unipolar, Bipolar)................................................................             6      672.65    10
     Slipped epiphysis
# R607 - closed reduction/traction ....................................................                  6      387.00    8

PDF page 620 / N40

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
PELVIS AND HIP
                                                                                              Asst         Surg         Anae
# R642 - closed reduction/internal fixation ........................................           6           502.30        8
# R627 - open reduction/fixation .......................................................       6           758.65        8
     Payment rules:
     1.F134 is not eligible for payment if percutaneous fixation of the sacrum or sacroiliac joint(s) is
       performed.
        2.F134 is not eligible for payment for application of a pelvic sling or MAST trousers to a pelvic
          fracture.
        3.E555 and E569 are not eligible for payment with F134 as this fee code includes rigid external
          fixation of anterior/posterior pelvic ring and/or percutaneous fixation of anterior pelvis.
        4.E569 is not eligible for payment with D059 for percutaneous fixation of the sacrum and/or
          unilateral SI joint as this is included in D059
        5.Open reduction of acetabular or femoral head or hip fracture or dislocations include
          arthrotomy and/or removal of loose body(ies) if performed.
        6.F101 includes reduction and fixation of trochanteric fracture if performed.
        7.R628 is not eligible for payment with D042
        [Commentary:
        Open reduction codes for pelvic fractures should only be claimed when the operative
        procedure includes exposure of the fracture with reduction and internal fixation. Minimally
        invasive, image-guided reduction without fracture exposure and with percutaneous fixation
        does not constitute open reduction.]
     Sacro-coccygeal
  UVC - closed reduction .................................................................                visit.fee
# D061 - open, removal of coccyx.....................................................            6         193.00          6
     Congenital/developmental dislocation of the hip
# R404 - closed reduction (includes tenotomy and cast) ..................                                  190.20          7
# R405 - repeat (includes cast) .........................................................                  131.80          6
# R406 - open reduction (includes tenotomy and arthrotomy) ..........                            7         472.35          7

Master, record 858. Record Layout PDF, page 1.

D04220260401999999990000268250000000000000000000000000000095760000000957600

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.